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�P��'I" SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />SOIL SUITABILITY STUDY REQUIREMENTS CHECKLIST <br />1-t— <br />_ <br />SITE LOCATION: `a 2 ' Ltv'�- C'a X ` � PA #: - /r <br />REPORT DATE: I ` 7 4 <br />S = Sufficient <br />1 = Insufficient <br />San Joaquin County Development Title Chapter 9-1105, Section 9-1105.2 <br />S <br />1 <br />1.0 <br />INTRODUCTION & PROPOSED DEVELOPMENT SECTION <br />,Er <br />❑ <br />1.1 <br />Description of site, including zoning information. <br />P— <br />❑ <br />1.2 <br />Description of proposed development. <br />3.1 <br />❑ <br />1.3 <br />Parcel vicinity location map. <br />JT <br />❑ <br />1.4 <br />Site map showing location of all items on parcels (i.e., structures, drives, wells, septic systems, large trees, <br />3.3 <br />Discussion of on-site septic tank repair history. <br />�] <br />pastures, pools, natural drainage courses, ponds, waterways, etc.) <br />2.0 <br />PRESENT AND PAST USES OF THE SITE SECTION <br />1_1�1 <br />❑ <br />2.1 <br />Discussion of past and present uses at the site to assess potential problems. <br />3.0 <br />EXISTING AND PROPOSED SEPTIC TANK USAGE SECTION <br />❑ <br />3.1 <br />Description of exiting on-site septic tank usage (system types, age, functioning/repair rates). <br />❑ <br />3.2 <br />Site septic permit history (number/types/dates of permits, age of system, permit numbers, copies in report). <br />❑ <br />3.3 <br />Discussion of on-site septic tank repair history. <br />�] <br />❑ <br />3.4 <br />Description of existing septic tank usage in the general area (system types, ages, functioning/repair rates, <br />proximity to parcel). <br />❑ <br />3.5 <br />General area septic permit history (number/types/dates of permits, age of system, permit numbers, copies in <br />report). <br />=� <br />❑ <br />3.6 <br />Discussion of general area septic tank repair history. <br />�' <br />❑ <br />3.7 <br />Description of proposed or expected maximum (including second unit dwellings) septic tank usage on site. <br />4.0 <br />GROUNDWATER INFORMATION SECTION <br />'�] <br />❑ <br />4.1 <br />Description of the depth and gradient of groundwater in the general area. <br />,� <br />❑ <br />4.2 <br />Description/discussion of any existing and/or potential groundwater contamination issues in the general location <br />of the site. <br />lei'❑ <br />4.3 <br />Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where <br />water sample(s) were obtained. <br />.ET <br />❑ <br />4.4 <br />Description of constituents being tested for in the water sample. <br />Z <br />❑ <br />4.5 <br />Description of how sample was obtained, handled, stored, and transported to the lab. <br />❑ <br />4.6 <br />Complete Chain of Custody document, including printed and signed name of third party sampler, condition of <br />sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory <br />report to include the above noted information. <br />EHD 26-03 <br />Page 1 of 3 SOIL SUITABILITY STUDY CKLST <br />4/24/12 <br />